Friday, 26 February 2010


Thought I would write about something I really dont understand but recognise in my day job as a surgeon and my hobby as an ironman.

The concept of flow to me is what it feels like to be travelling effortlessly downstream in a fast moving river where you are in control and expending minimal effort. This not to be confused with flow of blood in an artery for instance which whilst important is something altogether different. I will try to expand upon this...

Complex operations can take 4-6 hours to complete and are not unlike an ironman (ok maybe a half ironman event) in many ways. There is always a lot of preparation involved in undertaking planned major surgery, there is the event itself and then there is the recovery period afterwards (both for me and my patient!). Leaving aside the patient side (although not to ignore it as there are plenty of things I can do for my patient before they undergo a procedure to improve there chances of a successful outcome) there are plenty of things I need to put in place before an operation in much the same way as you would plan your race before you do it.

Assuming the planning goes well and the organisation works I can sometimes find myself operating without stress or worry. Whilst the process is challenging anything that disrupts the progress can be rapidly circumvented and overcome and the operation seems to flow seamlessly through to a hopefully successful completion. Some people talk about being in "the zone" which I guess is much the same thing.

Experience tells me that this situation can be difficult to sustain. External and internal factors come into play. Most external factors can be controlled; keeping the environment quiet without unnecessary interruptions such as mobile phones, not having other activities requiring my attention planned into the same time period, having clear understanding of the working relationship and responsibilities of those around me. Internal factors such as self confidence, frustration, anxiety and so on are more challenging but again are overcome by familiarity with the procedure, planning for the unusual or unexpected and maintaining a sense of progression towards the goal of completion of the procedure all help to sustain the flow.

Now tell me there are not parallels in IM racing. The external factors are largely beyond your control by the time you start your race but will hopefully be accounted for by your preparation, training, equipment, nutrition plan and so on. Finding the flow or getting in the zone comes when you have got all this controlled and after 20 + weeks of focused training you find yourself in the race doing the things just as you planned. The challenge comes when things start to "get complicated" much like they can in a complex operation. It is how you respond at this point and how you get back into the flow that can determine your race. When the legs start hurting, the nausea kicks and fatigue starts to limit your performance how do you manage it.. can you focus adjust and then get back on track or do you splinter and come to a messy halt?

The resilience and resolve to stay on track is clearly crucial to my patients when I am operating and I think is enhanced by my knowledge of the physical and mental reserves I have developed through IM racing.

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